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Indiana

Indiana Behavioral Health Credentialing And IHCP Enrollment

If you’re a behavioral health provider getting credentialed in Indiana, taking Medicaid means four answers. You enroll once with the IHCP, then contract by program, because Hoosier Healthwise, HIP, Hoosier Care Connect and PathWays each carry a different plan list. Commercial runs on CAQH by statute, and a carrier that sits on a clean application past fifteen business days must credential you provisionally and, once the contract is executed, pay back to that date. Here’s the order, what clean means, and what only you can sign.

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Indiana Payers And Timelines

Where The Delays Happen

Getting On A Panel Isn’t The Same As Getting Paid.

In Indiana the delay usually starts before the clock does. A carrier has five business days to tell you a file has an error, and the fifteen business day clock never starts on an application that comes back. On the Medicaid side the wait sits between one state enrollment and four different plan rosters. We work all of it and tell you which step you’re in.

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Four Medicaid Programs. One Blue. One Statute Worth Knowing.

Two Tracks

Saying “I take Indiana Medicaid” is four or five different answers here. The commercial side is simpler on paper and has a legal clock behind it that almost no provider knows about.

Indiana Health Coverage Programs

Enroll Once With The IHCP. Contract By Program.

Indiana runs Traditional fee-for-service alongside four managed care programs, each with its own plan list. Hoosier Healthwise covers children and pregnant members. The Healthy Indiana Plan covers most working-age adults. Hoosier Care Connect covers aged, blind and disabled members under 60. PathWays for Aging, live since July 1, 2024, covers members 60 and older. There’s no statewide behavioral health carve-out, though UnitedHealthcare routes its Indiana behavioral health through Optum on both of its Medicaid lines.

How you enrollThrough the IHCP Provider Healthcare Portal, run on CoreMMIS by Gainwell Technologies. Paper still works through the Provider Enrollment Packet Finder. Start from the Provider Enrollment Type and Specialty Matrix, version 11.1 dated March 26, 2026, which lists the documents each type owes and flags what can’t enroll from out of state. A solo practice that bills directly enrolls as a billing provider. A clinician under a group enrolls as a rendering provider, and the group signs an IHCP Rendering Provider Agreement for each one at each service location.
One thing we resolve by phone, not by guessingAn advanced practice nurse enrolls under provider type 09. The specialty list under 09 covers pediatric, obstetric and family nurse practitioners, clinical nurse specialists, CRNAs and certified nurse midwives, and we found no psychiatric nurse practitioner option in it. So which specialty a psych NP should carry is an open question, and we put it to Indiana Medicaid provider enrollment directly before filing. Guessing puts a client under the wrong specialty and breaks their billing in a way that’s hard to trace later.
Sequencing, in orderIHCP first, plans second. The managed care entities check the state side before a contract moves, so the IHCP Provider ID has to exist first. Then sequence by program. A general adult outpatient practice usually starts with the HIP roster, a child and adolescent practice with Hoosier Healthwise, and an older-adult panel sits in PathWays, which is a completely different plan set. Anthem is the one plan that covers all four.
Two lines that separate a clinician from a programThe specialty behavioral health services sit behind certification by the FSSA Division of Mental Health and Addiction, and the matrix says so plainly. Ordinary outpatient psychiatric evaluation and medication management billed by a licensed prescriber doesn’t run through that door. The application fee, $750 for enrollments received in 2026, lands on institutional providers per service location rather than on individual professionals, and an ordering, prescribing, referring enrollment carries none.

Commercial

Here, CAQH Is The Law.

Indiana never built a state credentialing portal. It did something simpler: IC 27-8-11-7(e) has the Department of Insurance prescribe the CAQH application form and requires both the applying provider and the credentialing insurer to use it. Anthem holds the Blue license for the whole state, so there’s no second Blue to chase.

Your CAQH is a single point of failureOne profile feeds every commercial application in the state, which is good news right up until it lapses. A stale attestation makes every file unclean at once and hands back the fifteen business day clock across all of them. You complete and attest your own profile. We’re added as an authorized practice manager, so we keep the practice data current during your project and get each carrier authorized. After that, Credentialing Maintenance keeps it current. If you want us to maintain your profile, you share access securely and change the password when we’re done.
The exception that catches everyoneEncore Health Network, one of the largest PPOs in Indiana, doesn’t subscribe to CAQH. It takes a paper copy of the fully completed CAQH application in place of its own form, with every supporting document and certificate attached. Authorize and forget, and the Encore application simply never existed. Authorizing CAQH is not the same as filing an application, and sufficiency has to be checked per payer.
Behavioral health has its own door at two carriersUnitedHealthcare’s is Optum, started inside Provider Express. Cigna’s is Evernorth. Aetna credentials behavioral health itself, on the same request for participation as medical. Anthem, CareSource, MHS and Ambetter, PHP and Encore all handle it in-plan. Applying through the medical door when the behavioral door is the real one is the most expensive mistake available in this state.
Seeing patients in other statesOne Anthem Indiana contract reaches Blue members elsewhere through BlueCard, and Aetna, Cigna and UnitedHealthcare are national. The gate is a license where the patient is, not another contract. Medicaid is the genuine exception, and Indiana adds its own wrinkle: an out-of-state entity can’t enroll as an Indiana behavioral health program, even where an individually licensed practitioner can.

Who You’ll Apply To, And How Long It Usually Takes.

Indiana Commercial Payers

These are typical ranges from a clean application. Indiana’s statutory clock is shorter than all of them, and it’s the carrier’s obligation rather than a date we control. We track it and push.

Anthem Blue Cross And Blue Shield

The anchor contract. Elevance Health is headquartered in Indianapolis.
  • Usually: Anthem describes credentialing as commonly 30 to 90 days. Plan on roughly 60 to 120 days from start to finish from a clean file to a countersigned contract
  • What it tells you: an application number when the participation request goes in, and notice within five business days if the file is incomplete, which lines up with the statute
  • CAQH: Anthem runs new Indiana enrollment through a digital tool on Availity that pulls straight from CAQH and returns a contract for electronic signature. Anthem has signaled a move to Availity Essentials during 2026, so confirm the current front door. It verifies your license directly with the Indiana licensing board
  • Why it’s heavier than it looks: all three State of Indiana employee plans run on Anthem’s National BlueCard PPO network with a Tier 1 HealthSync preferred tier, and Elevance closed its purchase of Indiana University Health Plans on December 31, 2024. Anthem’s Medicaid line is still a separate contract from commercial

UnitedHealthcare And Optum Behavioral Health

The strongest published opening in the state
  • Usually: about 60 to 120 days from a complete application. Optum says a Provider Relations Advocate turns around documentation questions within two business days
  • Published green light: Optum’s Indiana page recognizes Indiana as an any willing provider state and says it accepts applications accordingly. It lists MDs, DOs, PAs and RNs with prescriptive authority as sought in all Indiana counties, plus telemental health and medication-assisted treatment prescribers
  • CAQH: required, with a CAQH ID in place before you begin. Join Our Network has a separate button per provider type, so pick the individual clinician path rather than agency or facility
  • Watch: Optum also manages behavioral health for UnitedHealthcare’s PathWays for Aging and Hoosier Care Connect Medicaid lines, which are separate contracts from commercial

Separate door: Optum Behavioral Health

Aetna

Network need answered before credentialing
  • Usually: about 60 to 120 days from a clean file
  • Sequence: request for participation, network-need evaluation, credentialing pulled from CAQH, then contract finalization. Recredentialing generally every 36 months
  • Why that order helps: a no on network need arrives early rather than after months of paperwork
  • Watch: behavioral health goes through the same Aetna request for participation as medical

Same form: medical and behavioral health

Cigna Healthcare

Behavioral health goes through Evernorth
  • Current application route: Evernorth directs individual providers to its provider portal and publishes separate applications for clinics and facilities. We match you to the right provider category and its network requirements before anything goes in.
  • Published application timing: Evernorth says the process can take up to about 90 days. It wants your CAQH identification number on its behavioral provider information form and asks for re-attestation every 120 days
  • Bigger than it looks: Sagamore Health Network, one of Indiana’s long-standing PPOs, is a wholly owned Cigna subsidiary, so the Cigna footprint here exceeds its commercial member count

Separate door: Evernorth Behavioral Health

Ambetter From MHS Indiana

The Marketplace half of Centene in Indiana
  • Usually: roughly 60 to 120 days from a complete file. Confirm current turnaround at submission
  • Faster if you already hold MHS Medicaid: MHS treats adding a line of business to an existing contract as a network participation request and assigns a Request ID in the confirmation email, so the Marketplace add usually beats starting cold
  • CAQH: credentialing runs on CAQH with MHS authorized. Ambetter also asks behavioral health applicants for its Behavioral Health Provider Specialty Form
  • Watch: same company as your Medicaid MHS contract, different contract. Worth doing alongside the Medicaid side, because the paperwork overlaps and the intake is the same door

CareSource Indiana

Medicaid and Marketplace, on separate contracts
  • Usually: plan on roughly 60 to 120 days from a clean file. Confirm current turnaround at submission
  • Who it credentials: all licensed independent practitioners including behavioral health and non-physician practitioners. Its Indiana behavioral health guidance names advanced practice nurses credentialed in psychiatric or mental health nursing by name
  • Useful early signal: that same reference guide points at DMHA certification for the specialty program services, which tells you quickly whether your service mix is practitioner-billed or agency-gated
  • Watch: a nonprofit based in Dayton, Ohio, sitting on both sides of the Indiana market. Two contracts, not one

Physicians Health Plan Of Northern Indiana

The Fort Wayne plan. Acquired by Priority Health December 1, 2024.
  • Sequence: a Participation Application Request Form with professional liability documentation and your state license goes to the credentialing coordinator first. PHP then directs you to complete CAQH with primary source verification
  • Then: in PHP’s own words, once verification is complete you’re notified within 10 business days of the Credentials Committee recommendation and, if eligible, contacted by Provider Services to start contracting
  • Why bother: founded in 1983, serving more than 50,000 members across northern Indiana and into Ohio. If you practice in the Fort Wayne region or the northeast corner, the national carrier list doesn’t reach these patients
  • Watch: the Priority Health acquisition is recent enough that some directories and contracts still carry the old branding

Encore Health Network

The Indiana network people forget until a claim shows up
  • Usually: no published turnaround for the initial decision. Credentialing at application and then about every three years. Confirm at submission
  • The paper exception: Encore doesn’t subscribe to CAQH. It accepts a paper copy of your fully completed CAQH application in place of its own form, with all supporting documents and certificates. An authorize-and-forget habit leaves this one untouched
  • Why it earns its place: an Indianapolis PPO reporting more than 609,000 members, widely rented by self-funded Indiana employers and TPAs. A patient whose card says something else entirely may reach you through Encore
  • It credentials behavioral health explicitly: psychiatrists and physicians certified in addiction medicine, doctoral-level Indiana practitioners with the HSPP designation, LCSWs, LMFTs, LMHCs, and advanced nursing specialists including nurse practitioners and clinical nurse specialists

What Indiana Law Does And Doesn’t Give You

The most provider-friendly credentialing statute we have found anywhere
  • A fifteen business day clock, with a real consequence. IC 27-8-11-7 covers insurers and IC 27-13-43-2 covers HMOs, and they say the same thing. Five business days for the carrier to tell you an application has an error and why, five business days for you to respond, and if the carrier receives a clean application and fails to decide within fifteen business days it has to provisionally credential you under NCQA provisional credentialing standards and notify you. Provisional status holds until a determination is made
  • And then it pays you back. Once the carrier fully credentials a provisionally credentialed provider and a network provider agreement has been executed, reimbursement under that contract runs retroactive to the provisional date at your contracted rates. This is the carrier’s legal obligation. It isn’t something we can promise on their behalf
  • Read the conditions before you count on it. The whole thing turns on a clean application, defined as one containing no error and processable without being returned. And if the carrier ultimately denies credentialing, provisional status terminates on the date it notifies you of the adverse determination and it owes nothing for the provisional period. No executed agreement means no retroactive payment either, so credentialing approval alone doesn’t get you there
  • One precision note we won’t smooth over. The statutory text we could reach says business days in both chapters. Some secondary legal databases render the HMO section as calendar days. Treat business days as the working assumption and confirm against the current Indiana Code text before relying on the exact count in a dispute
  • CAQH is prescribed by statute. IC 27-8-11-7(e) has the Department of Insurance prescribe the CAQH credentialing application form in electronic or paper format and requires both the applying provider and the credentialing insurer to use it. That’s why one lapsed attestation reaches every carrier at once
  • Any willing provider, with written reasons. IC 27-8-11-3 reaches hospitals, physicians, pharmacists and other providers, and says an insurer’s terms and conditions may not discriminate unreasonably against or among providers. Deny a provider and the insurer has to give written notice explaining the basis and naming the specific terms and conditions the provider doesn’t satisfy. It doesn’t force anyone to take you. It does mean a closed-panel answer in Indiana comes with a written reason you can act on
  • What it doesn’t reach. The commercial credentialing clock doesn’t apply to Medicaid managed care contracting, so don’t plan the IHCP side around it

Medicare and the IHCP managed care programs are government enrollment, which is $450 per provider for each Medicare, Medicaid or Medicaid plan enrollment and can be bought on its own or with a package. Humana in Indiana is a Medicare Advantage and Medicaid story rather than a commercial group one, having exited employer-group commercial medical nationally; here it shows up as Humana Healthy Horizons in PathWays for Aging. Indiana has also had real payment friction on the Medicaid side during 2026, with providers reporting long waits on managed care claims, so we set cash flow expectations honestly rather than optimistically.

Carry A Plan We Didn’t List? Add It.

State of Indiana employee coverage, building trades and UAW-affiliated Taft-Hartley trusts, self-funded employer plans through a TPA, rented PPO networks. You name the plan, we find the real route. A large share of Indiana employer coverage is self-funded and leases network access rather than buying insurance, so the card names a TPA or the employer while the network behind it’s Anthem, Encore, Sagamore or a national carrier. We identify the network from the card rather than chasing the administrator, because the contract you need is with the network. State employees reach you through your Anthem contract rather than a separate state agreement, and whether you sit in the Tier 1 HealthSync preferred tier is its own conversation with Anthem. We confirm which network and application your practice needs.

Send These Once And We Can Start.

What We Need From You

  • Your individual NPIPlus a Type 2 if you bill under a group. The Indiana managed care entities check the IHCP side before a contract moves, so both have to exist and be active.
  • Active Indiana license and DEAFrom the Indiana Professional Licensing Agency, for your provider type. IPLA licensure is a named document in the IHCP matrix, and Anthem verifies it directly with the licensing board.
  • CAQH attested and each payer authorizedStatutory here, not housekeeping. A stale profile makes every application unclean at once and forfeits the fifteen business day clock. You attest it. We keep it current during your project.
  • A printable full copy of that CAQH applicationWith supporting documents and certificates. Encore doesn’t subscribe to CAQH and accepts the paper copy instead, so an authorization-only approach leaves that one sitting.
  • Delegated IHCP portal accessSo we can complete your enrollment and each managed care request without password sharing. Confirm the mailing address on your enrollment profile too. Revalidation notices go there at 60 days and again at 30.
  • Legal business name, EIN, and W-9One per tax ID. The federal W-9 is a required document inside every IHCP enrollment packet.
  • Malpractice certificateNaming you, or a carrier-produced roster face sheet. PHP asks for professional liability documentation at the very first step, before it will send you to CAQH.
  • Five years of work historyMonth and year, with any gap over six months explained. In Indiana this is worth more than usual: an unexplained gap is exactly the error that makes a file unclean and gives away the statutory clock.
  • Rendering provider agreements, if you’re under a groupThe group signs an IHCP Rendering Provider Agreement for you at each service location, and has to produce current signed agreements again at revalidation.
  • Your service mix, honestlyIf any part of the plan is a certified program rather than an office visit, the IHCP matrix wants a DMHA certificate attached. This is a flag we confirm, not advice we give.

Two dated changes that alter the size of the panel you’re joining. Healthy Indiana Plan work requirements begin enforcement January 1, 2027 for members and applicants ages 19 to 64 who aren’t pregnant and not Medicare eligible, at 80 hours a month of work, half-time school, apprenticeship, a work program or volunteering, met for the three months before applying or renewing. That makes October through December 2026 the first lookback months. The exemption list is long and includes people who are medically frail or living with serious mental illness, people in substance use treatment, caregivers of children 13 or younger, pregnant and 12 months postpartum members, tribal members, former foster youth under 26, and the recently incarcerated. Separately, House Enrolled Act 1277 pulls long-stay nursing facility residents out of PathWays for Aging and back into fee-for-service starting July 1, 2027. Neither changes how you enroll. Both change who’s enrolled.

Indiana certifies behavioral health organizations through the FSSA Division of Mental Health and Addiction, separately from your own professional license, under rules in 440 IAC. The categories are built around programs rather than office visits: a Community Mental Health Center has to offer six core areas including inpatient, residential and partial hospitalization, and the regime is written around governing boards, accreditation and audits. Where it turns real for a small practice is Medicaid, because the IHCP matrix requires a DMHA certificate for the CMHC, Adult Mental Health and Habilitation, Behavioral and Primary Healthcare Coordination, Child Mental Health Wraparound, MRO Clubhouse, Mobile Crisis Unit, CCBHC, opioid treatment and SUD residential specialties. Adding addiction treatment, crisis work, residential settings or unlicensed staff delivering treatment is the usual point where the question turns live. We ask about your staffing model and service mix during onboarding and confirm where you land before it can hold up a payer contract. We don’t tell you whether you need a certification, we don’t publish the rules, and we don’t file it for you.

We handle credentialing and payer enrollment in Indiana and in the other 49. Physicians and outpatient medical groups, psychiatrists included, start on the physician credentialing page.

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Payer decisions, timing and rates aren’t ours to promise, and we don’t promise them. Our own work is a different matter. If something we delivered doesn’t work the way we said it would, tell us within 30 days of delivery and we fix it at no cost. If we can’t fix it, or can’t deliver what you bought, we refund the part it affected. Payments aren’t refundable unless the problem is our mistake. A new request, another payer or provider, a change of scope or a new build gets quoted separately.

When we’re done, the paperwork is yours. Your NPPES record, CAQH/DataSpring profile, IHCP portal account and payer contracts stay in your name, and you keep all of it if we stop working together.

Indiana Credentialing Questions

Questions We Get

What Is Provisional Credentialing In Indiana And How Do I Get It?
Under IC 27-8-11-7 for insurers and IC 27-13-43-2 for HMOs, a carrier that receives a clean credentialing application and fails to issue a determination within fifteen business days has to provisionally credential you under NCQA provisional credentialing standards and tell you it did. That status holds until a determination is made. Once you’re fully credentialed and a network provider agreement is executed, reimbursement runs retroactive to the provisional date at your contracted rates. Fifteen business days is roughly three weeks against the 60 to 120 days that’s normal everywhere else. It’s the carrier’s legal obligation, not a promise we can make for them, and it only fires if the application was clean.
What Makes A Credentialing Application Clean In Indiana?
The statute defines it as an application that contains no error and can be processed by the carrier without being returned. That definition is what matters most. A stale CAQH attestation or one unexplained work-history gap makes the file unclean, the clock never starts, and the provisional credentialing and back pay never attach. The carrier has five business days to tell you what’s wrong and why, and you get five business days to respond. Getting a file clean on the first pass is precisely the work.
Which Indiana Medicaid Plans Do I Need?
It depends on who you see, because Indiana splits Medicaid into four managed care programs with different plan lists. Hoosier Healthwise and the Healthy Indiana Plan are Anthem, CareSource and MHS. Hoosier Care Connect is Anthem, MHS and UnitedHealthcare. PathWays for Aging, for members 60 and older, is Anthem, Humana and UnitedHealthcare. Anthem is the only plan in all four, which is part of why it’s the first contract we go after. MDwise stopped serving Hoosier Healthwise and HIP on January 1, 2026 after FSSA ended its contract, so any Indiana checklist still listing MDwise is out of date.
Which Provider Type Does A Psychiatric Nurse Practitioner Enroll Under In Indiana Medicaid?
An advanced practice nurse enrolls under provider type 09, Advanced Practice Registered Nurse. The specialty list under type 09 covers pediatric, obstetric and family nurse practitioners, clinical nurse specialists, CRNAs and certified nurse midwives, and we didn’t find a psychiatric nurse practitioner option in it. So which specialty a psych NP should carry is a real open question, and it’s one we put to Indiana Medicaid provider enrollment on the phone rather than guessing at. Filing under the wrong specialty is how a practice ends up with claims denying for a reason nobody can find months later. We’d rather make the call.
Can I Enroll In Indiana Medicaid From Out Of State?
It depends on whether you enroll as a person or as a program, and Indiana is unusually clear about it. The IHCP matrix marks a long list of behavioral health program specialties as ineligible for out-of-state enrollment entirely, including outpatient mental health clinic, community mental health center, adult mental health and habilitation, child mental health wraparound, mobile crisis unit and CCBHC. Individually licensed practitioners are treated differently and have an out-of-state column, as do physicians and advanced practice nurses. So an Indiana-licensed prescriber sitting in another state can usually still enroll, while an out-of-state entity trying to enroll as an Indiana outpatient mental health clinic can’t. That decides how a multi-state telehealth practice has to be structured, which is why we check it before anyone signs a lease or forms a business.
Do I Have To Enroll With Indiana Medicaid If I Never Bill It?
If you order, prescribe or refer for an IHCP member, yes. The IHCP states it directly: reimbursement for services or supplies resulting from a practitioner’s order, prescription or referral requires that provider to be enrolled. So the denial lands on the pharmacy or the receiving provider rather than on you, which is exactly why nobody notices until a patient calls from the counter. Indiana has a lighter ordering, prescribing, referring enrollment built for this, and it carries no application fee.
Is My CAQH Profile Enough For Every Indiana Payer?
Almost, and the exception is expensive. Indiana wrote CAQH into statute: IC 27-8-11-7(e) has the Department of Insurance prescribe the CAQH form and requires both the applying provider and the credentialing insurer to use it. But Encore Health Network, one of the largest PPOs in the state, doesn’t subscribe to CAQH. It accepts a paper copy of the fully completed application in its place, so authorizing CAQH and assuming you’re done leaves an Encore application that never existed. Authorizing isn’t the same as filing, and we check sufficiency per payer rather than per state. You complete and attest your own profile.
How Long Does Credentialing Take In Indiana?
Plan on 60 to 120 days per commercial payer from start to finish, from a clean file to a countersigned contract. Anthem describes the credentialing step alone as commonly 30 to 90 days and issues an application number with a five business day notice if the file is incomplete. PHP in Fort Wayne notifies you within 10 business days of its Credentials Committee recommendation once verification finishes. The fifteen business day statutory clock is shorter than any of those numbers, and it only runs on a clean application, which is why we spend the time up front rather than in the follow-up.

Related

Keep Reading

Indiana PMHNP scope of practiceWhat Indiana allows you to do, separate from who pays you.
Illinois credentialing and payer enrollmentThe state credentials Medicaid providers itself, and a new law reaches the behavioral carve-outs.
Ohio credentialing and payer enrollment90 days, and the strongest late-payment remedy we have found anywhere.
Kentucky credentialing and payer enrollmentAny willing provider tested at the Supreme Court, and payment during the wait.
Michigan credentialing and payer enrollmentAnother state where an unenrolled prescriber kills the pharmacy’s claim.
Opening your own practiceBusiness setup, identifiers, payers, EHR, and billing setup.
Adding a provider to your clinicFirst-time credentialing into contracts you already hold.
Changing your business or tax IDMoving panels without breaking the money.

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Official Pages For Indiana

Indiana Medicaid Provider Enrollment (IHCP)Enroll or revalidate as a Medicaid provider.Indiana Department of Insurance Bulletin 132 Credentialing ApplicationThe state's credentialing rules for health insurers.Indiana State Board of NursingNurse practitioner (APRN) licensing.Indiana Behavioral Health and Human Services Licensing BoardLicensing for therapists and counselors.DataSpring Provider Data Portal (formerly CAQH)The credentialing application this state's rules name.

Where This Comes From

Links checked automatically on October 14, 2026. A source carries that stamp only when its page loaded and had not changed since the date we verified it.

We last reviewed this page on October 1, 2026. Each source listed shows the date we last verified it, and we will review the whole page again by December 28, 2026.

Payer programs, plans and timelines change. Everything here carries a verification date and gets re-checked on a review cycle. We will check these facts again by December 28, 2026. Approval and effective dates are controlled by each payer and by the state. This page covers payer operations. It isn’t legal, tax or scope of practice advice.

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